1. SOCIAL MEDICINE AND/OR PUBLIC HEALTH Assoc. Prof. Petko Salchev, MD, PhD

2. SOCIAL MEDICINE AND/OR PUBLIC HEALTH? Confrontation between them is inappropriate due to the fact that public health is a division of social medicine, its field of application and a direction of testing different approaches to health problems of the whole nation and achieving the maximum possible positive health for all people.

3. Spheres of interaction, defining the integrated systematic nature of social medicine Social sciences: Biostatistics Anthropology Demography Ecology Economics Epidemiology Management Pedagogy Political sciences Sociology Others Natural sciences: Anatomy Chemistry Microbiology Molecular biology Pharmacology Pathology Psychology Others Clinical sciences: Internal diseases Surgery Obstetrics and Gynecology Pediatrics Others Social medicine

4. Social life Concordance of certain interests, restraint of uncertainty and effective management of conflicts, allowing the development and maintenance of stable social structures Two levels: Micro-level – the ability of the individual to interact directly with other individuals (face to face); Macro-level – characterized by anonymity, the functioning of faceless organizations and typically associated with the nation or state.

5. The theory of Wissenschaftsiehre The formation of a given science discipline as an independent science in the system of scientific knowledge is possible if it satisfies at least three fundamental criteria : – It must have its own distinct field of study; – It must have its own methodology; – It must have a concrete subject to which the results of scientific investigations are applied.

6. Main aspects of human health, studied by social medicine The influence of social factors on health; The influence of health on social factors; The social subject of healthcare activities – the individual as a social category, the group and society as a whole; The social subject of healthcare activities – healthcare systems

7. Subject of social medicine The subject of social medicine is more difficult to define and perceive in comparison to other medical disciplines. The subject of social medicine is public health as a complex systemic phenomenon.

8. Methodology of social medicine The methodology of social medicine is the systemic study of the complex influence of social and biological factors on public health and all social aspects of human health.

9. Social aspects of human health Public health Influence of social factors on health Influence of health on social factors Social subjectSocial object

10. Subject of social medicine Subject of social medicine are the forms, approaches and activities for preservation and enhancement of people’s health.

11. Definition Social medicine is an integrative science, which subject is the study of public health as a whole system, governed by specific laws, as well as the systemic analysis of the influence of social factors on public health.

12. Structure of social medicine (V. Borisov, 1998) 1. Fundamental social medicine – includes the basic theory and methodology of social medicine 2. Borderline disciplines – medical sociology, history of medicine and healthcare, medical ethics and deontology, medical demography, medical geography, health economics, health pedagogy and education, biostatistics. These disciplines reflect the interaction of medical theory with various social sciences. 3. Profile disciplines, reflecting the integrative interaction between medical disciplines and social theory – public health, epidemiology, etc. 4. Applied sciences – reflecting the possible approaches to practical public health problems – health economics, health management, health policy, health legislation, etc.

13. Main functions of social medicine - Methodological - Integrative - Socio-ethical - Governing

14. Methods of social medicine Historical Sociological Statistical Epidemiologic Economical Mathematical modeling Experimental

15. PUBLIC HEALTH In 1920 C.E.Winslow, a professor of public health in the University of Wales defines public health as a “science and art of: 1. Disease prevention; 2. Health elongation 3. Health promotion through organized public efforts for: – Hygienic treatment of the environment; – Infection control; – Health education of individuals; – Organization of medical and nursing care for early diagnosis and preventive care; – Development of social mechanisms for stable living standard, promoting health, organization of medical aid in a way that every individual can exercise his right of healthy and prolonged life.”

16. Subject of public health The subject of public health comprises the various forms, approaches and activities in solving health problems or to put it otherwise, it is the practical expression of the theoretical foundations and concepts of social medicine

17. The focus (mission) of public health is the health intervention and is rather to prevent, than to treat, through surveillance of cases and health promotion.

18. Approaches in solving health problems Direct – these include all activities like childhood immunizations, birthrate control, control of hypertonic disease, diabetes, etc. The indirect approaches (methods) of public health aim to protect the individual on the basis of extensive public support, like raising standards for healthy environment, safe water supply, system for waste treatment and better nutrition.

19. Validation of health intervention Right to be healthyPublic expectations and social norms, legislation Public supportNGOs, media, individuals Needs – epidemiological, clinical, socialDisease, mortality, handicap and disability, physiological indicators Available technologiesDocumented efficacy, safety, experience, acceptability, accessibility Preceding experience and skillsPractices of leading public health centers with proven effect Legislative restrictions and setbacksJudicial and court decisions Government, regions, providers of health services Expenditures and benefitsDirect expenditures for the health service, indirect expenditures for individuals, families and society Social acceptabilityMedia and public opinion LeadershipPolitical and professional Quality of lifeOptimization of human capabilities

20. Spheres of influence of public health 1. Genetic and biological factors; 2. Behavioral factors (way of life); 3. Environment, including economical, social, cultural and physical factors; 4. Organization of the health service

21. Functions of public health Health surveillance, control and analysis; Identification of diseases, epidemics and health risks; Development, management and control of health promotion and disease prevention programs; Provision of opportunities and empowering the community for health promotion and fighting inequalities; Provision of stable development of inter-sector cooperation for health strengthening and reducing inequalities; Provision of legislation adequacy of health protection and promotion; Support of well-trained and highly qualified staff, multi-discipline experts and public health groups; Effective implementation of health services to meet the aims of health promotion, disease prevention and reducing inequalities; Studies, development, assessment and innovations; Provision of quality for public health functioning.

22. Standards in public health VisionHealthy people in healthy communities MissionHealth promotion and disease prevention Objectives Epidemics and disease control Environmental protection Occupational health Health promotion Medicine of disasters Identification of public health problems and keeping good health status of the population Required services Monitoring of health status to identify public health problems Diagnosing and exploring health problems in the community Informing, educating and empowering people to take health-related decisions Developing policies and plans, supporting individual and public efforts for achieving better health Establishing laws and norms for health protection and occupational safety Linking people to their necessary health services and health care provision Providing expert work force in the field of public health Assessing efficacy, availability and quality of health services Research for new methods solving public health problems

23. Features of public health Complexity Multi-discipline Philosophy Active approach Functional dependency upon environmental determinants Sphere of influence over environmental factors

24. Definition Public health is a functional model for applying the theoretical concepts of social medicine in practice and an active approach to health promotion and protection for individuals and society, based on balancing between sanitary measures, environmental actions, health promotion, personal and community based health services, in coordination with a wide variety of treatment and rehabilitation health services.